Impacted Tooth

A tooth is said to be impacted when it remains stuck in gum tissue or bone and is not in occlusion(contact) with opposite tooth

Tooth impaction: A condition in which tooth fails to fully grow out

(erupt) from gums or underlying bone.

Teeth start to pass through the gums (emerge) during infancy. this happens again when permanent teeth replace the primary teeth. If a tooth does not come in or emerges only partially, it is considered to be impacted. This most commonly happens with the wisdom teeth (3^rd set of molars) they are last teeth to erupt they usually come in between the ages of 17 and 21.

CAUSES:

Normal eruption of teeth can be disturbed due to various factors such as mechanical obstacles, odontomas, ankylosis and various other medical syndromes.

An impacted tooth remains stuck in gum tissue or bone for various reasons.

• The area may be overcrowded leaving no room for tooth to emerge. For example, the jaw may be too small to fit the wisdom teeth.
• Teeth may also become twisted, tilted, or displaced as they try to emerge. this results in impacted teeth.

While you can’t prevent impacted teeth, you can reduce the risk for the problems they cause. Practice good oral hygiene and consider having your impacted teeth removed if they start causing problems.

TYPES OF IMPACTED TEETH:

Impaction for 3^rd molars can be broadly classified into 4 types

• Angular impaction
• Partial impaction
• Horizontal impaction
• Vertical impaction

Most commonly used classification system with respect to treatment planning, depending on the angulation the tooth might be classified as

• Mesioangular
• Horizontal
• Vertical
• Distoangular
• Palatal
• Buccal
• Lingual

*Mandibular third molars are the most frequently impacted teeth, followed by maxillary third molars, maxillary canines, mandibular premolars and maxillary incisors.

SIGNS AND SYMPTOMS:

There may be no symptoms of a fully impacted tooth, unless it starts pushing pressure on adjacent tooth.

Partially emerged tooth can trap food, plaque and other debris in the soft tissue around it, which can lead to inflammation and tenderness of the gums and unpleasant mouth Odor. This is called pericoronitis.

PERICORONITIS:is an infection of soft tissue that covers the crown of an impacted tooth and is usually caused by the normal oral microbiota. Another common cause is entrapment of food beneath the gum flap (also called operculum).

The retained debris may also lead to decay on the wisdom tooth or the neighbouring tooth or even bone loss.

OTHER SYMPTOMS:

• Bad breath
• Difficulty in opening mouth
• Pain or tenderness of the surrounding gums
• Prolonged headache or jaw ache
• Redness or swelling of the gums around the impacted tooth
• Swollen lymph nodes of neck (occasionally)
• Unpleasant taste when biting down on or near the area

EXAMS AND TEST:

*Diagnosis is based on clinical examination coupled with imaging, especially cone beam CT(CBCT) scans, OPG and IOPA

Dentist will look for swollen tissue over the area where a tooth has not emerged or has only partially emerged.

The impacted tooth may be pressing on nearby teeth. the gums around the area may show signs of infection such as redness, drainage and tenderness. (As gums swell over impacted wisdom teeth it is called as pericoronitis)

Dental X-rays confirm the presence of impacted teeth and its position inside the jaw bone or gums.

POSSIBLE COMPLICATION OF IMPACTED TOOTH

• Abscess of tooth or gum area
• Chronic discomfort in the mouth
• Infection
• Malocclusion of teeth
• Plaque trapped between teeth and gums
• Periodontal disease on the neighboring tooth
• Nerve damage, if the impacted tooth is near a nerve in the jaw called mandibular nerve.

TREATMENT:

Treatment options may include:

• Waiting and monitoring: If your impacted tooth isn’t causing any symptoms your dentist may suggest a wait-and see approach. with this approach, instead of surgically removing the tooth, your dentist will regularly monitor it so that they can see if any problem develops. This is easy if you go in for regular dental checkups

• Surgery: if you are experiencing pain and other unpleasant effects from an impacted tooth, your dentist recommends extraction surgery, particularly in case of impacted wisdom teeth. They may also recommend extraction if the impacted tooth will have a negative effect on adjacent teeth

• Eruption aids: when the canine teeth are impacted, eruption aids may be used to get the tooth to erupt properly. Eruption aids may include braces, brackets, or by extraction of teeth that is blocking canine eruption.

->No treatment may be needed if an impacted wisdom tooth is not causing any problem.

->If impacted tooth is somewhere towards the front, braces may be recommended to help put the tooth into proper position

->Removal of tooth is the usual treatment for an impacted wisdom tooth. this is done in the dentist’s office.

->Extraction is almost always done as an outpatient procedure, so you’ll go home the same day.

Extraction procedure includes

1. Sedation or anesthesia: you may have local anesthesia, which numbs your mouth; sedation anesthesia that depresses your consciousness
2. Tooth removal: during extraction your dentist or oral surgeon makes an incision in your gums and removes any bone that blocks access to the impacted tooth root. After removing the tooth, the dentist typically closes the wound with stiches and pack the empty space(socket)with gauze.

Medication will be prescribed by dentist to help if the impacted tooth causes discomfort. warm saline rinses (half teaspoon salt in one cup warm water) may be soothing to the gums.

Post extraction instructions:

• Keep the cotton pack, biting it tightly for next 1 hour
• Do not spit outside for next 6-8 hours, keep swallowing saliva
• Do not rinse out/ Gargle for next 8-10 hours. Do passive rinsing
• Apply ice externally for 10 to 15 minutes. every hour for next 6-8 hours
• Have liquids with glass and do not use straw
• Have soft and cold diet for next 3-4 days
• Start rinsing with warm saline water after 24 hrs and continue 4 to 5 times daily for next 3 to 4 days
• Take medication as prescribed by your dentist
• Stich removal to be done after 7 days

Much less commonly, some people may experience:

• Painful socket, or exposure of bone if post-surgical blood clot is lost from the socket
• Infection in the socket from bacteria or trapped food particles
• Bleeding from site of extraction.

If any of the above symptoms are noticed you can contact your dentist

When to contact your dentist:

If you suspect you have an impacted tooth, see your dentist as soon as possible. they can examine your teeth and take an X-ray of your mouth to determine if an impacted tooth is causing your symptoms, if it is they can discuss the benefits and risk of treatment

• When you have an unemerged tooth or partially emerged tooth and you have pain in the gums or other symptoms
• Redness around partially erupted tooth
• Difficulty in opening mouth
• Pain while chewing on the side of impacted molar
• Bad breath.

OUTLOOK:

Impacted teeth aren’t always a problem, and in some cases, there is no need to treat them. Other times, however they must be removed to prevent infection, damage to other teeth or other complication.

Regular dental checkups from an early age can help your dentist identify impacted teeth early on and offer a treatment plan when necessary.